Staged bilateral total shoulder arthroplasty: improved outcomes with less than 6 months between surgeries.

BACKGROUND: Research on optimal timing of bilateral anatomic total shoulder arthroplasty (TSA) is lacking. The purpose of this study was to investigate functional outcomes in patients undergoing bilateral anatomic TSA to understand the ideal timing for the second arthroplasty. METHODS: Patients who underwent bilateral TSA for osteoarthritis between 2000 and 2012 with a minimum follow-up of 12 months since their most recent surgery were evaluated. Postoperative patient-reported outcomes (University of California-Los Angeles [UCLA] shoulder rating scale, Constant score, and Simple Shoulder Test [SST]), biometrics (strength and range of motion), and a subjective questionnaire were compared for 4 "interval groups" based on timing between surgeries: <6 months, 6 to 12 months, 12 to 24 months, and >24 months. RESULTS: Eighty-two shoulders (41 patients, 70 ± 9 years old) were analyzed. Mean postoperative UCLA, Constant, and SST scores were 29, 72, and 9 points, respectively; 83% of patients reported satisfaction with both shoulders. Patients with <6 months between surgeries demonstrated significantly better UCLA scores than 6- to 12-month interval patients (P = .04), greater Constant scores compared with all other groups (P < .001), and greater SST scores compared with 6- to 12-month and 12- to 24-month interval patients (P = .002), with no differences in length of follow-up between groups. CONCLUSION: In the absence of extrinsic factors, such as convenience, changes in social support structure, or changes in health status, patients may be advised that having the second surgery within 6 months of the first might optimize their postoperative functional outcomes and satisfaction compared with waiting a longer interval between surgeries.

Return to play after anterior cruciate ligament reconstruction in major league baseball athletes.

PURPOSE: The purpose of the study was to (1) investigate the rate of return to play among Major League Baseball (MLB) athletes after anterior cruciate ligament reconstruction (ACLR), (2) determine the impact of ACL injury on ability to perform baseball-specific planting and pivoting tasks (batting and stealing bases), and (3) to explore the effect of the injured side on these metrics. METHODS: ACL injury data from 1999 to 2012 were compiled, along with player performance statistics recorded for players with at least 30 games before ACL injury. Predictor variables included side of injury and outcome variables focused on batting average, stolen bases, and number of times caught stealing before injury and after surgery. RESULTS: Twenty-three of 26 (88%) players were able to return to at least 30 games after ACLR, although they experienced a decline of 21.2% in number of games played (P = .004). Those who had a ACLR for a rear batting leg injury averaged a 12.3% decline in batting average, whereas those who had ACLR for a lead leg injury had a 6.4% increase in batting average (P = .04). Side of injury was not predictive of stolen base metrics. CONCLUSIONS: The overall rate of return to play among MLB position players after ACLR was 88%, although there was a 21.2% decline in the number of games played postoperatively. Injury to the rear batting leg resulted in a lower returning batting average compared with an injury to the lead batting leg. Side of injury had no effect on stolen bases or on the number of times a player was caught stealing. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Clinical Outcomes After Suture Anchor Repair of Recalcitrant Medial Epicondylitis.

This study evaluated clinical and patient-reported outcomes and return to sport after surgical treatment of medial epicondylitis with suture anchor fixation. Consecutive patients were evaluated after undergoing debridement and suture anchor repair of the flexor-pronator mass for the treatment of medial epicondylitis. Demographic variables, a short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, Oxford Elbow Score (OES), and 10-point pain and satisfaction scales were collected. Ability and time to return to sport after surgery were evaluated, and the relationship between predictor variables and both elbow function and return to sport was investigated. Median age at the time of surgery was 55 years (range, 29-65 years), with median follow-up of 40 months (range, 12-67 months). Median QuickDASH score and OES at final follow-up were 2.3 (range, 0-38.6) and 45 (range, 22-48), respectively. Most patients returned to premorbid sporting activities at a median of 4.5 months (range, 2.5-12 months), whereas 4 patients (14%) reported significant limitations at final follow-up. Older age at the time of surgery was predictive of better QuickDASH score and OES (P=.05 and P=.02, respectively). Patients who underwent surgery after a shorter duration of symptoms had better outcomes, but the difference did not reach statistical significance (QuickDASH, P=.09; OES, P=.10). Surgical treatment of recalcitrant medial epicondylitis with suture anchor fixation offers good pain relief and patient satisfaction, with little residual disability. Older age at the time of surgery predicts a better outcome.